Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Invest Ophthalmol Vis Sci. 2019 Apr 1;60(5):1595-1603. doi: 10.1167/iovs.18-26534.
To compare the characteristics of macular and extramacular white spots on wide-field swept-source optical coherence tomography angiography (SS-OCTA) and optical coherence tomography (OCT) images in diabetic retinopathy (DR).
We retrospectively reviewed 107 eyes of 64 patients with DR, of whom nominal 12 × 12 mm SS-OCTA images centered on the optic disc and ultrawide field photographs were acquired. White spots on fundus photographs corresponded to hyperreflective lesions in the superficial en-face OCT images, and the characteristics of these white spots were investigated. We compared such OCT findings with the vertical and horizontal extents of nonperfused areas (NPAs) on OCTA images.
We observed 136 white spots and corresponding hyperreflective lesions in 49 eyes. The hyperreflective lesions in the extramacular areas had greater areas (P < 0.001) and more frequently spanned from the nerve fiber layer to the outer plexiform layer (P < 0.001), while those in the macula were superficial. All of macular hyperreflective lesions were accompanied with nerve fiber layer defects, whereas only 18 (15.4%) of 117 extramacular lesions had them (P < 0.001). Comparative studies showed that most extramacular hyperreflective lesions corresponded to the NPAs in the whole layers on OCTA images, compared to the lamellar NPAs of the superficial layer in most of the macular lesions (P < 0.001). The NPAs extended to the peripheral side more frequently in the extramacular hyperreflective lesions compared with macular lesions (P < 0.001).
This study proposed that most of the extramacular white spots may be discriminated from macular spots with respect to diabetic NPAs on OCTA images.
比较宽视野扫频源光相干断层扫描血管造影（SS-OCTA）和光相干断层扫描（OCT）图像中糖尿病视网膜病变（DR）黄斑和周边白色斑点的特征。
我们回顾性分析了 64 例 107 只 DR 眼，这些眼均获得了以视盘为中心的 12×12mm SS-OCTA 图像和超广角照片。眼底照片上的白色斑点与浅层 OCT 图像中的高反射病变相对应，并对这些白色斑点的特征进行了研究。我们将这些 OCT 发现与 OCTA 图像上无灌注区（NPA）的垂直和水平范围进行了比较。
我们在 49 只眼中观察到 136 个白色斑点和相应的高反射病变。周边区域的高反射病变面积较大（P＜0.001），更常从神经纤维层延伸到外丛状层（P＜0.001），而黄斑区的病变较浅。所有黄斑区高反射病变均伴有神经纤维层缺损，而 117 个周边病变中仅有 18 个（15.4%）有缺损（P＜0.001）。对比研究显示，与大多数黄斑病变的浅层层状 NPA 相比，OCTA 图像上大多数周边高反射病变与全层 NPA 相对应（P＜0.001）。与黄斑病变相比，周边高反射病变的 NPA 更常延伸到周边侧（P＜0.001）。
本研究提出，在 OCTA 图像上，大多数周边白色斑点可能与糖尿病 NPA 区分开来。
